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Brain MRI Lesions are Related to Bowel Incontinence in Multiple Sclerosis
Author(s) -
Fröhlich Kilian,
Linker Ralf A.,
Engelhorn Tobias,
Dörfler Arnd,
Lee DeHyung,
Huhn Konstantin,
Schwab Stefan,
Hilz Max J.,
Seifert Frank,
Winder Klemens
Publication year - 2018
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12589
Subject(s) - medicine , supramarginal gyrus , multiple sclerosis , lesion , defecation , parahippocampal gyrus , secondary somatosensory cortex , radiology , pathology , temporal lobe , functional magnetic resonance imaging , psychiatry , epilepsy
BACKGROUND AND PURPOSE Bowel incontinence in multiple sclerosis might be associated with specific lesion sites. This study intended to determine associations between bowel incontinence and cerebral multiple sclerosis lesions using a voxel‐wise lesion symptom mapping analysis. METHODS We conducted a retrospective study of multiple sclerosis patients with self‐reported bowel incontinence and matched controls. Lesions were manually outlined on T2‐weighted MRI scans and transformed into stereotaxic space. We performed a voxel‐wise subtraction analysis subtracting the lesion overlap of patients without from patients with bowel incontinence. Finally, we compared the absence or presence of bowel incontinence between patients with and without lesions in a given voxel using the Liebermeister test. RESULTS A total of 51 patients were included in the study. The analysis yielded associations between bowel incontinence and lesions in the supramarginal gyrus of the left secondary somatosensory cortex and another lesion cluster in the right parahippocampal gyrus and amygdala. CONCLUSIONS Our analysis indicates associations between bowel incontinence and lesions in the left supramarginal gyral area contributing to integrating anorectal‐visceral sensation and in the right parahippocampal gyrus and amygdala contributing to generating visceral autonomic arousal states. Moreover, our results suggest left hemispheric dominance of sensory visceral integration, while limbic areas of the right hemisphere seem to contribute to the autonomic component of the defecation process. A limitation of our study is the retrospective evaluation of the bowel incontinence status based on medical records. Further research should evaluate the bowel incontinence status in multiple sclerosis patients prospectively to overcome the limitations of the current study.